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News from the British Columbia Naturopathic Association
Your Health
VOLUME 16 / NUMBER 3 / SUMMER 2010
Fall 2010: Enhanced Primary Care in BC
Improvements to Primary Care, Patient Choice & Access to Preventive Care
As of this fall, many of BC’s licensed
naturopathic physicians (NDs) will be
permitted to prescribe medications
for patients. This will enhance the
existing care NDs currently provide
and improve primary care options for
patients across the province.
Below we’ve listed some common
questions received by patients over
the last few months concerning the
improvements to scope of practice.
Why do Naturopathic Doctors Need
Prescription Medications?
Making a prescription is fundamental
to the practice of medicine in any and
all forms. But prescribing pharmaceuticals is not the central focus of
naturopathic medicine—it is simply a
facet of providing timely and effective
primary care.
Another critical element, however, is
that over the decades NDs have lost
access to many botanical medicines
and natural therapeutics. These “traditional” substances, such as high
dose vitamins, some amino acids,
hormones, botanicals and herbs,
which NDs have used for decades,
have slowly become “scheduled”—
meaning prescription only.
Even more importantly, NDs are providing primary care without the capacity to practice at the full extent of their
education, training and expertise.
Naturopathic physicians have traditionally acted as primary care practitioners and continue to do so today.
As such, it is imperative that NDs be
allowed to retain their historical right
to prescribe.
Don’t Naturopathic Doctors Only Use
“Natural” Medicines?
No and yes. Even to this day many
prescription drugs are derived from
natural sources—where there is overlap and emphasis in naturopathic
medical training.
Some “natural”
medicines are prescription only (e.g.,
amino acids, high-dose vitamins).
But really this is a question about employing basic medical diagnosis and
laboratory analysis.
Naturopathic
doctors’ primary focus is on treating
the underlying nature or cause of disease. Put simply, naturopathic medicine is the “nature” of the “pathos” or
disease, not “natural” medicines stand
alone. This focus is about supporting
the natural healing processes of the
patient, not only using a product.
Thus, naturopathic medicine is about
the removal of any impediment to the
healing process; the prevention and
treatment of physical and mental disease, disorders and conditions; and
the promotion of good health using
not only natural methods but methods
that support and enhance a patient’s
overall health.
Unfortunately, even those “natural”
medicines naturopathic doctors have
used for many decades are often,
now, by prescription only.
How Does Prescribing Impact Patients?
NDs offering prescriptions, when appropriate, will improve patient care.
The improvement will increase access
to traditional medicaments (e.g., high
dose vitamins, minerals, hormones),
restoring core elements of ND expertise. In respect to a patient who requires medication but seeks primary
care from an ND, they can avoid additional trips to another practitioner
for refills. For patients seeking nondrug alternatives, the ND will now be
able to adjust, if appropriate, drug
regimens while introducing non-drug
therapies.
That said, consider the alternative
which limits patient care: Without the
ability to prescribe, the lack of access
to pharmaceuticals puts NDs in a position of ambiguity. It leads to confusion both on the part of the practicing
ND and the patient, vis-à-vis patient
protocols. This discrepancy carries
with it an inherent danger to the public
and to the naturopathic profession. A
case in point is bronchial pneumonia
where the ND deems antibiotics are
required, yet cannot prescribe them.
An inability to prescribe places the patient at risk due to the delay in receiving proper medical treatment.
Continued on page 4
Inside
YH
IV Therapy
2
Cardio Health: Surgical Alternatives
3
Health Headlines
6-7
Reconsidering
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8
LANDMARKS
Advancements in Care
Continued from page 1
As a Patient, I See an ND to Avoid
Taking Prescription Medications. Why
is the Profession Becoming Just Like
MDs?
Naturopathic medicine is focussed on
each patient’s distinct health needs.
NDs seek to find the safest, most
effective, least invasive therapy and
medicament for treatment. Historically this has always been the case
and at present it’s the case—none of
those tenets will change.
Instead, patient care is being enhanced, without losing the emphasis
on non-drug treatments. In fact, for
most protocols there are valid nondrug alternatives. But in some cases,
even if only temporarily, prescription
medicine may be an important element in helping a patient heal in a
quick and complete manner.
An important caveat is this: In US jurisdictions, where NDs have prescribed
for many years, they haven’t evolved
into MDs or lost their identity as NDs.
They still provide safe, effective, patient-centred health care, using drugs
judiciously, only as needed and when
appropriate.
Do Naturopathic Physicians have the
Education Required to Prescribe Medicines?
NDs already prescribe pharmaceuticals in many jurisdictions across North
America. They could not prescribe if
their education excluded pharmacology and pharmacognosy training.
[Pharmacognosy is the study of medicines derived from natural sources.
The American Society of Pharmacognosy defines pharmacognosy as
“the study of the physical, chemical,
VOL 16 / NO 3 / SUMMER 2010
biochemical and biological
properties of drugs, drug
substances or potential
drugs or drug substances
of natural origin as well as
the search for new drugs
from natural sources.”]
There are no NDs in BC
without at least seven
year medical training. All
licensed NDs complete a
minimum of three-years
university level pre-medical
training, then four years at
an accredited naturopathic
medical college. (There are
two in Canada and four in
the USA.)
For many decades, BC’s naturopathic physicians have been seeking from government
recognition for a scope of practice in keeping with the contemporary and historical
practice of NDs. In the 2008 Throne Speech,
the BC Liberals made a commitment to proceed with two facets of naturopathic medical care: prescriptive rights and diagnostic
facility access. The process leading to this
announcement involved many years of negotiation, research, and collaborative assessment. The government’s commitment is
based on this lengthy and detailed process; it
is a commitment based on sound judgement
having reviewed the educational criteria,
current and historical practice of NDs, and,
most importantly, ensuring the highest levels
of patient-centred health care are available
to all British Columbians. The BCNA believes
that this commitment is the right choice for
British Columbians: It reduces the existing
burden on MDs while ensuring the provision
of safe and effective primary health care in a
measured fashion.
Following pre-med, the
four-year ND program covers many of the same science courses as at “conventional” medical school.
Drug education is of course a core
part of pharmacology training, but
also an inherent part of biochemistry,
microbiology, physiology, botanical
medicine, pathology and other core
science courses in the ND curricula.
Further, BC’s NDs complete intensive
additional pharmacology upgrade
courses and exams prior to prescribing.
Why do Naturopathic Physicians Want
to Prescribe?
Strictly speaking, naturopathic doctors don’t “want” the change in regulation, they require it—to provide safe,
effective, economical preventative
health care. The ability to prescribe
is in keeping with a “shared scopes of
practice” model being implemented
across the province whereby many
health professions have access to
prescription items relevant to their
respective practice. The change is in
keeping with the record of safety and
effectiveness of this profession, and
ensuring that modalities arbitrarily
removed, over time, continue to be
used appropriately and in a timely
fashion.
What About Patient Safety? If Naturopathic Physicians Haven’t Dealt With
Prescription Drugs in the Past, How
are they Eligible for the Added Responsibility?
Naturopathic doctors deal with prescription medicines on a daily basis:
With patients already on a drug regime, considering pharmaceuticals
and/or an alternative, drug/non-drug
interactions, and myriad other interconnected health issues. The substantial change in regulations won’t
be so much an added responsibility,
but rather the ability to improve paPAGE 4
Naturopathic Medical Education Comparative Curricula
tient care. Currently, hundreds
of thousands of BC residents see
NDs for care, many for primary
care, and BC’s licensed NDs attend to over a million patient visits
each year.
Won’t it Confuse Patients Already
on Prescription Medications?
Given the shared scopes of practice model already in existence,
there shouldn’t be confusion. Many
patients may see, for example, an
ND, physiotherapist, chiropractor, acupuncturist and MD over
the course of a year, sometimes
simultaneously. Shared scopes of
practice is the status quo in BC.
Even for a patient seeing both a
general practitioner and specialist, they may be under two different “allopathic” protocols without
confusion or error.
Comparing Curricula of Naturopathic Medical Schools,
Conventional Medical Schools, and Non-accredited “N.D.” Programs
National
College of
Naturopathic
Medicine
Bastyr
UniversityNaturopathic
Medicine
Federally &
Regionally
Accredited
Naturopathic
Medical
School
Federally &
Regionally
Accredited
Naturopathic
Medical
School
Yale
University
Johns
Hopkins
Medical
College of
Wisconsin
Federally & Federally & Federally &
Regionally
Regionally
Regionally
Accredited
Accredited
Accredited
Conventional Conventional Conventional
Medical
Medical
Medical
School
School
School
Trinity
College of
Natural Health
Clayton
College of
Natural Health
Non-accredited
Naturopathic
Medical
Training
Non-accredited
Naturopathic
Medical
Training
Basic and Clinical Sciences:
Anatomy, Cell biology, Physiology, Histology, Pathology, Biochemistry, Pharmacology, Lab diagnosis,
Neurosciences, Clinical physical diagnosis, Genetics, Pharmacognosy, Bio-statistics, Epidemiology, Public Health,
History and philosophy, Ethics, and other coursework.
100
1548
1639
1420
1771
1363
272
Clerkships and Allopathic Therapeutics:
including lecture and clinical instruction in Dermatology, Family Medicine, Psychiatry, Medicine, Radiology,
Pediatrics, Obstetrics, Gynecology, Neurology, Surgery, Opthamology, and clinical electives.
0
2244
1925
2891(+thesis)
3391
2311
0
Naturopathic Therapeutics:
Including Botanical medicine, Homeopathy, Oriental medicine, Hydrotherapy, Naturopathic manipulative therapy,
Ayurvedic medicine, Naturopathic Case Analysis/Management, Naturopathic Philosophy, Advanced Naturopathic
Therapeutics.
300
588
633
0
0
0
336
But this question also begs a furTherapeutic Nutrition
50
ther clarification: There is a differ144
132
0
0
0
176
Counseling
ence between prescriptions for
Included in
Included in
Included in
chronic and acute conditions. A
144
143
0
25
psychiatry
psychiatry
psychiatry
patient on medication for, say, de(see above)
(see above)
(see above)
pression, and seeing an ND, would
TOTAL HOURS OF TRAINING
require immediate attention for an
4668
4472
4311+thesis
5162
3674
784+dissertation 475+dissertation
acute condition such as bronchiNB:
Clayton
College,
an
unaccredited
correspondence
school
in
Alabama,
no longer accepts students.
Sources:
tis. The provision for access to
Curriculum Directory of the Association of American Medical Colleges
www.trinityschool.org/nd.php
scheduled drugs allows for
more effective, timely and apNot every prescription is a “drug”: Many “traditional” substances, such as
propriate medical care.
Will all NDs in BC be Licensed
to Prescribe?
No, each naturopathic doctor has the choice whether to
complete an upgrade course
or not. Upon taking the course
and passing a competency
exam the regulatory board,
the College of Naturopathic
Physicians, will permit members to prescribe. In turn,
Pharmaceutical Services will
issue prescribing numbers to
certified NDs.
VOL 16 / NO 3 / SUMMER 2010
high dose vitamins, some amino acids, hormones, botanicals and herbs, which
NDs have used for decades, have slowly become “scheduled”—right here in
B.C. Imagine a medical doctor losing the ability to run diagnostic tests or prescribe an antibiotic, or a surgeon unable to use anaesthetics. That’s exactly
what’s happened over the years to naturopathic doctors in terms of many traditional medicines.
In addition, naturopathic physicians have demonstrated extensive education
and training as well as historical and contemporary safe and effective usage
of scheduled substances, especially those items which have been moved
from over-the-counter status to prescription only. The safety record speaks
for itself. Naturopathic medicine, like allopathic medicine, is an evolving art
and science and as such requires a formulary and legislation that reflects the
changing nature of medicine and health care. Further, being granted the right
to prescribe represents the trend in most health care professions. Examples
include pharmacists, psychologists, nurse practitioners, midwives, optometrists, etc.—some of whom have considerably less clinical education than
NDs.
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